Document Detail

Renal involvement in the systemic inflammatory reaction syndrome.
MedLine Citation:
PMID:  9509564     Owner:  NLM     Status:  MEDLINE    
Uncontrolled infection quite often leads to systemic inflammatory reaction syndrome (SIRS) and multiorgan dysfunction (MOD) syndrome. Thirty-five consecutive patients (19 males) fulfilling strict diagnostic criteria for SIRS were enrolled in two multicenter prospective double-blind trials involving new therapies for SIRS. The patients were followed prospectively up to day 28 after the enrollment. In the 35 patients with SIRS, males predominated in the age group below 40 (10/12, 83%) compared to the older group (nine males out of 23, 39%). Out of 16 females presenting with SIRS, only two were below the age of 40. This distribution was statistically different than our general MICU population. The serum albumin in these patients was uniformly low, with a mean of 22.5 gm/L. The bulk of SIRS patients (22/35; 63%) went on to develop acute renal failure (ARF). Although statistically not different, skin and peritoneal infections were more common in ARF group while pulmonary infections in non-ARF group. The majority of blood-cultures grew gram-positive organisms. Resolution of SIRS occurred within first 3 days in greater number of non-ARF survivors than ARF survivors (6/9, 66.7% vs. 6/16, 37.5%). Of the 22 ARF patients, 17 showed improvement in their renal function; the five who did not, died before day 28. The overall mortality (about 32%) was similar in both groups. Patients who developed both ARF and ARDS did not survive. In conclusion. SIRS occurs mostly in elderly patients, almost always in patients with low albumin levels. Premenopausal women seem to be protected. Blood cultures isolated a gram-positive organism in the majority of cases. Improvement in serum creatinine suggests good prognosis. The mortality in ARF and non-ARF groups is similar.
A M Karnik; R Bashir; F A Khan; C P Carvounis
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial    
Journal Detail:
Title:  Renal failure     Volume:  20     ISSN:  0886-022X     ISO Abbreviation:  Ren Fail     Publication Date:  1998 Jan 
Date Detail:
Created Date:  1998-05-08     Completed Date:  1998-05-08     Revised Date:  2008-05-21    
Medline Journal Info:
Nlm Unique ID:  8701128     Medline TA:  Ren Fail     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  103-16     Citation Subset:  IM    
Department of Medicine, Nassau County Medical Center and State University of New York at Stony Brook 11554, USA.
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MeSH Terms
Antibodies, Monoclonal / therapeutic use
Bradykinin / antagonists & inhibitors
Case-Control Studies
Double-Blind Method
Kidney Failure, Acute / etiology*,  microbiology,  mortality
Middle Aged
Multiple Organ Failure / etiology*,  microbiology,  mortality
Prospective Studies
Risk Factors
Systemic Inflammatory Response Syndrome / complications*,  microbiology,  mortality,  therapy
Tumor Necrosis Factor-alpha / immunology
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/Tumor Necrosis Factor-alpha; 58-82-2/Bradykinin

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